Provider Demographics
NPI:1164024741
Name:DANG, NICOLE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DANG
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1358
Mailing Address - Country:US
Mailing Address - Phone:973-330-3557
Mailing Address - Fax:
Practice Address - Street 1:174 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1358
Practice Address - Country:US
Practice Address - Phone:973-330-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03259000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist